In Reply.—We share Dr Leonard's opinion that the activity seen within both kidneys (Fig 2) could suggest either a right-to-left cardiac shunt or deficiencies in the preparation of the lung-imaging agent.
Before submitting the manuscript, we carefully examined the patient for possible congenital heart disease, that condition having been reported to be associated with congenital lobar emphysema.1 We found no clinical evidence of heart involvement; however, definitive heart studies were not done in this patient. We also did not find substantiating evidence for an associated hyposplenism or asplenia. The patient's RBC morphology was normal; findings on sickle cell preparation were negative and no HowellJolly bodies were seen in the peripheral blood smear.
One additional point might be made concerning abdominal organ visualization. Take-up of radioactive material in abdominal organs can be explained on the basis of breakage of the bondage of the radioactive compound, with subsequent transmission through